Higher D-dimer Levels Research Articles

Association of thrombophilic genes (MTHFR, MTR and MTRR) polymorphisms and homocysteine level in relation to the increased risk of thrombosis among COVID-19 patients

BackgroundPatients with COVID-19 have an increased risk of thrombosis and coagulopathy. Homocysteine, an amino acid essential to coagulation, is thought to be involved in such conditions, as its level is mediated by the presence of some single nucleotide polymorphisms (SNPs) in certain genes including MTHFR, MTR and MTRR. AimThe current study aimed to assess the significant role of MTHFR (C677T and A1298C), MTR A2756G and MTRR A66G SNPs as risk factors for thrombosis among Egyptian COVID-19 patients and their effect on homocysteine level. Subjects and methodsThis case-control study was carried out on 90 Egyptian COVID-19 cases, divided into 45 non-complicated cases and 45 complicated cases with thrombosis, in addition to 80 healthy control individuals. DNA was isolated from blood samples of all the participants. The genotyping was performed using real-time PCR; in addition, serum homocysteine level was estimated. ResultsThe MTHFR (C677T and A1298C), MTR A2756G and MTRR A66G variants revealed a significant higher risk of thrombosis under different genetic models including the homozygous comparison of the co-dominant (20 % vs. 2.3 %, OR = 15.88, p = 0.007), the dominant (62.2 % vs. 33.3 % OR = 3.29, p = 0.006) and the allelic models (41.1 % vs. 17.8 %, OR = 3.2, p < 0.001) for MTHFR C677T and also the dominant (77.8 % vs. 51.1 %, OR = 3.3, p = 0.008) and the allelic models (52.2 % vs. 31.1 %, OR = 2.4, p = 0.004) for MTHFR A1298C. In addition, the heterozygous comparison of the co-dominant (60 vs. 11.1, OR = 12.7, p < 0.001), the dominant (62.2 % vs. 11.1 %, OR = 13.1, p < 0.001) and the allelic models (32.2 % vs. 5.6 %, OR = 8.08, p < 0.001) for MTR A2756G and the heterozygous and homozygous comparisons of the co-dominant model [(53.3 % vs. 31.1 %, OR = 3.4, p = 0.03) and (13.4 % vs. 2.2 %, OR = 12.0, p = 0.049), respectively], the dominant (66.4 % vs. 33.3 %, OR = 4.0, p = 0.001) and the allelic models (40 % vs. 17.8 %, OR = 3, p = 0.001) for MTRR A66G. Moreover, MTHFR (C677T and A1298C), MTR A2756G, and MTRR A66G variants were also associated with high levels of serum homocysteine (p = 0.045, 0.001, 0.005 and 0.039, respectively). The homocysteine level was related to the disease severity by its correlation with higher LDH (rs = 0.49, p < 0.001), CRP (rs = 0.44, p < 0.001), IL-6 (rs = 0.46, p < 0.001) and D-dimer (rs = 0.66, p < 0.001) levels. The multivariate regression analysis showed that homocysteine and the dominant models of MTHFR (C677T and A1298C), MTR A2756G and MTRR A66G were independent predictors of susceptibility to thrombosis among COVID-19 patients [(OR = 1.02, p = 0.007), (OR = 1.15, p = 0.043), (OR = 1.2, p = 0.024), (OR = 1.42, p < 0.001), (OR = 1.19, p = 0.021), respectively]. ConclusionMTHFR (C677T and A1298C), MTR A2756G, and MTRR A66G gene variants were associated with high homocysteine and D-dimer levels that carried a risk for thrombosis among COVID-19 patients and associated with the disease progression.

Hyper fibrinolysis state in COVID 19 and its correlation to lipid parameters

BackgroundCoronavirus disease 2019 (COVID 19) is associated with systemic effects involving especially the respiratory and cardiovascular system. The unique features of this condition are disseminated intravascular coagulation, excess fibrin degradation products due to abnormality in the coagulation system that could independently predict mortality. Abberations in lipid parameters that normally predict cardiovascular disease (CVD) were compared with D-dimer levels as risk markers in patients with COVID 19. MethodsA hospital based cross sectional study was conducted over a period of five months in patients aged 30 to 70 years diagnosed with COVID-19. The patients were categorised based on the D-dimer levels as: Group I <0.5μg/ml (Normal), Group II 0.5-2.0μg/ml (Intermediate high), Group III >2.0μg/ml (Very high). The lipid parameters, atherogenic indices were compared between the three groups. ResultsThe mean age of the selected COVID-19 patients was 49.3± 19.1 years of which 63 were males and 37 females (2:1). Significantly high D-dimer levels were detected which had a weak positive correlation with TG, Atherogenic Index Plasma (AIP). Significant rise in TC, LDL and Non-HDL was seen in Group II. Increasing trend of AIP was seen across the groups. D-dimer showed a weak positive correlation with TG, AIP and statistically non-significant negative correlation with rest of the lipid parameters. ConclusionThough an overall increase in D-dimer, TG and AIP was observed in COVID-19 patients, categorization based on D-dimer status detected lowering LDL and increasing AIP on deterioration of disease state.

The relationship of clinical presentation, d-dimer levels and previous SARS-CoV-2 positivity in outpatients with suspected pulmonary embolism

Abstract Introduction Elevated D-dimer levels can be detected in patients with pulmonary embolism (PE), but also in patients with the disease caused by the novel coronavirus (COVID-19). Aims To investigate relationship between clinical presentation, D-dimer levels and previous SARS-CoV-2 positivity in outpatients with suspected PE. Material and methods This retrospective study included 609 consecutive outpatients (mean age 68±15 years, 50% female) who underwent computed tomography pulmonary angiography for suspected PE from 2021 to 2023. By reviewing electronic databases, clinical and laboratory data were collected, as well data on previously documented SARS-CoV-2 infection. Results PE was confirmed in 130 (21%) patients who had higher D-dimer values than patients without PE (p&amp;lt;0.001). Patients with previous COVID-19 had significantly higher D-dimer values compared to those without prior COVID-19, but only during the first 8 months from infection to pulmonary angiography (Figure, upper panel). Clinical probability of PE, as indicated by Geneva score [odds ratio (OR) 2.36, 95% confidence interval (CI) 1.55 – 3.58)], and age-adjusted D-dimer (OR 4.52, 95%CI 1.58 – 12.90) were independently associated with PE, while previous COVID-19 was not. Main clinical reasons for emergency department presentation are shown in Figure (bottom panel). In 45/609 (7.4%) patients evaluated primarily for elevated D-dimer, the prevalence of COVID-19 in the previous 6 months was higher in those with PE compared to those without PE (100% vs. 49%, p=0.019). Conclusion Within 8 months of infection, patients with a history of COVID-19 had higher D-dimer levels than those without COVID-19. Age-adjusted D-dimer and standard clinical probability scores retained their predictive power in outpatients with suspected PE, regardless of COVID-19 history.

Combined activation of complement and coagulation is associated with myocardial injury in ST-elevation myocardial infarction

Abstract Introduction Experimental data indicates that the complement system and the coagulation cascade can activate each other. The magnitude of this interaction in acute myocardial infarction is not known. We aimed to investigate a possible association between complement activation and coagulation activation in patients with acute ST-elevation myocardial infarction (STEMI), as well as how they relate to myocardial injury estimated by troponin T (TnT) and myocardial function assessed by echocardiography. Purpose To increase the understanding of the interaction between complement activation and coagulation activation in STEMI, and the clinical relevance to myocardial injury. Methods Blood samples were drawn after percutaneous coronary intervention (PCI) in 864 patients with STEMI. Myocardial function was measured as left ventricular ejection fraction (LVEF), estimated by visual approximation or Simpson biplane method within 3 months. Complement activation was assessed by ELISA of circulating levels of the terminal complement complex (TCC). Activation of coagulation was assessed by ELISA of prothrombin fragment 1+2 (F1+2) and D-dimer, and endogenous thrombin potential (ETP), analyzed by calibrated automated thrombogram assay. Results TCC was weakly correlated to F1+2 (r=0.086, p=0.012), D-dimer (r=0.176, p&amp;lt;0.001) and ETP (r=0.144, p&amp;lt;0.001). In univariate linear regression analysis, this association persisted for D-dimer and ETP. When adjusting for associated covariables, the association only persisted for ETP (Table 1). Patients with above-median TCC and D-dimer had significantly higher peak TnT (Figure 1). In logistic regression, having combined above-median TCC and D-dimer was predictive of an LVEF ≤40% (Table 2). Conclusion In this large STEMI cohort, complement activation by TCC was weakly associated with coagulation activation. Combined high levels of TCC and D-dimer were linked to higher peak TnT and lower LVEF, possibly reflecting greater myocardial injury. The interaction between complement and coagulation activation might be relevant for clinical outcomes in STEMI patients and warrants further investigation.

Trousseau syndrome with recurrent cerebral infarction as the first oneset in a gastrointestinal malignant tumor patient: A case report.

Trousseau syndrome (TS) is a thrombosis disorder characterized by a hypercoagulable state linked to underlying malignancies, resulting in various thrombotic events such as deep vein thrombosis, pulmonary embolism, and arterial thrombosis. This syndrome serves as a crucial indicator of malignancy and can often be the first sign of an underlying tumor. In this case, we report a case of gastrointestinal malignant tumor as the first onset, and analyzes its clinical characteristics to improve the clinicians' understanding of this kind of disease. A 69-year-old woman was admitted to the hospital 4 times in 1 month for cerebral infarction. The patient was admitted several times with a new cerebral infarction lesion and a high D-dimer level, a persistently positive fecal occult blood test, and a gastrointestinal tumor was later found. The patient was diagnosed with TS, attributed to her underlying malignancy. During hospitalization, the patients were treated with aspirin for antiplatelet, esomeprazole for protection of gastric mucosa, atorvastatin for lowering blood lipids, butylphthalein for improvement of collateral circulation, edaravone dextrocamphorol for scavenging oxygen free radicals, and betahistine hydrochloride tablets for preventing dizziness. The patient's condition improved significantly after initial treatment, but died of the tumor a year after discharge. Currently, TS has a complex and varied clinical presentation and is relatively difficult to diagnose, especially in patients with an unknown tumor history. Focus should be placed on patients with recurrent cerebral infarctions and increased D-dimer levels, and anticoagulation may be an effective treatment for patients with TS.

Suspected contained rupture of a coronary artery aneurysm followed by a re-rupture: a case report

Abstracts Background Most coronary artery aneurysms (CAAs) are clinically asymptomatic and are only detected incidentally during cardiac imaging. However, CAAs can cause fatal complications such as cardiac tamponade following a rupture. Reports of contained ruptures of CAAs are limited. Case Summary An 89-year-old man had a severe, acute-onset chest pain two days prior. The patient was referred to our hospital because of residual dyspnoea and a fever. The blood tests exhibited high C-reactive protein (CRP) and D-dimer levels; moreover, contrast-enhanced computed tomography (CT) and transthoracic echocardiography revealed a diffuse mild pericardial effusion, which had not been detected six months prior. The fever and pericardial effusion persisted, and the main cause was not clearly understood. On day 19, the patient had a sudden loss of consciousness after chest pain. Contrast-enhanced CT showed an increase in the pericardial effusion, and coronary angiography showed a CAA in the proximal right coronary artery with extravasations that probably sealed. A re-rupture following a contained rupture of the CAA was considered, and it was suspected that the prolonged fever and pericardial effusion were related to the contained rupture associated with the first episode of chest pain. Discussion Our case showed that a contained rupture of a CAA can cause a fatal event by a re-rupture and may present with a prolonged fever and pericardial effusion. A contained rupture of a CAA should be considered as a differential diagnosis in patients with a prolonged fever and pericardial effusion of unknown origin after an acute onset of chest pain.

L-arginine, aminoguanidine and mesenchymal stem cells reduce the level of endoplasmic reticulum stress markers and D-dimer in the lungs of mice with antiphospholipid syndrome

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by damage to the intima of the microcirculatory blood vessels as a result of the formation of autoimmune antibodies to phospholipids of cell membranes. Recent data indicate a possible link between the occurrence of autoimmune diseases and endoplasmic reticulum stress, impaired nitric oxide availability, high plasma D-dimer level. The aim of the study was to estimate the effect of nitric oxide synthesis modulators L-arginine and aminoguanidine, and mesenchymal stem cells on the level of inositol-requiring enzyme-1a (IRE-1a), glucose-regulated protein 78 (GRP-78) as ER stress markers, and the level of D-dimer in the lung tissue of female BALB/c line mice with experimental APS induced with cardiolipin administration. 30 experimental animals were divided into five groups: 1 – control animals; 2 – mice with APS; 3 – mice with APS, injected intraperitoneally with L-arginine hydrochloride (25 mg/kg) and aminoguanidine (10 mg/kg); 4 – mice with APS, injected intraperitoneally with stem cells (5×106/kg); 5 – mice with APS, injected with L-arginine hydrochloride, aminoguanidine and stem cells in combination. After 10 days post APS formation animals were removed from the experiment, proteins were extracted from the lung tissue and their level was determined with Western blotting. It was established that in group with APS the levels of IRE-1, GRP-78 and D-dimer were substantially increased as compared to the control group. After separate administration of both arginine with aminoguanidine and MSC, as well as with their combined use, the level of IRE-1, GRP-78 and D-dimer decreased compared to the indices in animals with induced APS. The obtained data indicated that this effect is probably due to the reduction of ER stress through iNOS inhibition and the anti-inflammatory action of MSCs. Keywords: aminoguanidine, antiphospholipid syndrome, D-dimer, endoplasmic reticulume stress, GRP-78, IRE-1, L-arginine, lung, mesenchymal stem cells

Association between blood microplastic levels and severity of extracranial artery stenosis

Microplastics (MPs) contamination raises concerns about their impact on human health, particularly cardiovascular diseases. This study investigated the blood MPs levels in patients with extracranial artery stenosis (ECAS) and their possible link to disease severity. 20 ECAS and 10 control patients were recruited. Blood samples, collected before the digital subtract angiography (DSA) procedure, were analyzed by pyrolysis–gas chromatography mass spectrometry (Py-GC/MS), laser direct infrared (LDIR) spectroscopy, and scanning electron microscopy (SEM). Demographic and clinical information was also examined. Strict quality controls were implemented to prevent contamination. MPs were detected by Py-GC/MS in all blood samples, with concentrations significantly higher in ECAS group compared to control (174.89 ± 24.95 vs 79.82 ± 31.73 μg/g, p < 0.001), and polyvinyl chloride (PVC) and polyamide 66 (PA66) were the most abundant among the detected polymers. Further analyses suggested that higher concentrations of MPs may be associated with more severe artery stenosis (p < 0.001). Compared with the normal group, ECAS group had a higher level of D-dimer (0.61 ± 0.6 μg/L vs 0.28 ± 0.09 μg/L, p < 0.05) and longer Thrombin Time (sec) (18.30 ± 3.43 μg/L vs 16.25 ± 1.74 μg/L, p < 0.05). Additionally, LDIR and SEM detected the shape and physical properties of the MPs. In this study, we revealed significant higher blood MPs levels in ECAS patients, with a notable correlation between MPs concentrations and arterial stenosis severity.

Study of the relationships of polymorphisms of the folate cycle genes with the levels of homocysteine and folic acid as risk factors of cardiovascular disorders in the post-covid period

Enzymes of the folate cycle participate in the process of remethylation of homocysteine (HC) to methionine, where folates are coenzymes for methyl transfer. The aim of the work was to identify the interrelationships of gene polymorphisms of associations between folate cycle enzyme gene polymorphisms and cardiometabolic risk factors such as increased serum homocysteine levels and folic acid deficiency in patients in the post-covid period. In 51 patients who suffered from COVID-19, a general clinical and laboratory examination, and assessment of serum homocysteine and folic acid concentrations by immunoenzymatic method was carried out. Polymorphisms of the genes: methylenetetrahydrofolate reductase (677C&gt;T and 1298A&gt;C), methionine synthase-reductase (66A&gt;G) and methionine synthase (2756A&gt;G) were determined by real time polymerase chain reaction. For each of the named polymorphisms, the examined patients were divided into 3 groups according to the nucleotide alleles in the corresponding position: 1) homozygous dominant, 2) heterozygous and 3) homozygous recessive. For the methylenetetrahydro­folatereductase gene at position 677, serum levels of homocysteine and folate did not differ between the groups 1 and 2 with genotypes 677 C/C (n=26) and 677C/T (n=21), (p&gt;0.05); in group 3, the recessive genotype 677 T/T was found in only 4 people (8%), that did not allow comparison of indices. The distribution of patients into 3 groups according to the genotype of the same gene at position 1298 revealed that the recessive 1298 C/C mutation in group 3 (n=9) associated with an increased homocysteine level (19.56±1.89 μmol/l), versus 10.68±0.76 (p=0.012) and 11.63±1.25 μmol/l (p=0.013) in groups 1 and 2, with no difference in folate levels between groups. Group 3 differed by a higher degree of obesity, a higher frequency of hypertension disease and chronic heart failure (in 85% of patients in group 3, against 41 and 50% in groups 1 and 2), a higher number of platelets, a longer duration of hospitalization due to COVID-19, a higher level of D-dimer. The study of groups of patients, divided depending on the genotype of methioninesynthase reductase at position 66, showed that carriers of the recessive homozygous 66 G/G mutation (group 3, n=15) had increased serum homocysteine level (16.56±1.64 μmol/l) in comparison with individuals of group 1 (n=17) 66 A/A (10.28±1.17 μmol/l; p=0.004) and group 2 (n=19) 66 A/G (11.32±1.17 μmol/l, p=0.013). In group 3, a longer duration of hospitalization due to COVID-19 was noted (17.15±1.65 vs. 11.88±0.97 days, p=0.008), higher frequency of hypertension (67% vs. 35%) and heart failure (67% against 29%) compared to group 1. The use of a molecular genetic approach made it possible to establish that the presence of recessive mutations of the folate cycle genes is associated with a potential predisposition to hyperhomocysteinemia, thrombophilia, severe forms of cardiometabolic complications and coronavirus disease.

Impact of D-dimer on the outcomes of endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis.

There has been growing data about the association between D-dimer levels and thrombectomy outcomes in acute ischemic stroke patients (AIS) with no cumulative evidence. This systematic review and meta-analysis aim to discuss and analyze the findings of the current studies to provide more robust evidence in this regard. A systematic search was conducted through PubMed, Web of Science, Embase, and Scopus to retrieve all relevant investigations. A meta-analysis was conducted, and the results were presented in odds ratio (ORs) for binary variables and ratio of means (ROM) for continuous variables, each accompanied by its respective 95% confidence intervals (CIs). After searching and screening, 14 studies were included. The analysis showed that the low D-dimer group had significantly higher rates of favorable functional outcome (OR: 4.40; 95%CI: 2.65-7.30; p < 0.001, n = 3) and recanalization (OR: 4.13; 95%CI: 1.57-10.84; p = 0.004, n = 3) than the high one. The association between D-dimer levels and first-pass effect and re-occlusion risk was also demonstrated. Eventually, two studies also demonstrated a significant association between high D-dimer levels and deep venous thrombosis and symptomatic intracranial hemorrhage as post-thrombectomy complications. Current evidence indicates a significant association between D-dimer levels and post-thrombectomy outcomes in AIS patients. However, current data are remarkably heterogeneous, and additional comparative investigations are needed.

Incidence and Risk factors of Ischemic Stroke in Patients with Cancer-associated Venous Thromboembolism: From the COMMAND VTE Registry-2

BackgroundIschemic stroke is a serious complication in patients with cancer-associated venous thromboembolism (VTE), although data remain scarce in the direct oral anticoagulant (DOAC) era. ObjectiveTo investigate the incidence and identify predictive risk factors of ischemic stroke in patients with cancer-associated VTE (CAVTE). MethodsFrom the COMMAND VTE Registry-2 enrolling 5197 VTE patients across 31 centers in Japan between January 2015 and August 2020, we selected 1507 patients with active cancer. We calculated the cumulative incidence function of ischemic stroke accounting for the competing risk of death, and investigated risk factors of ischemic stroke in a subdistribution hazard model of multivariable analysis. ResultsDuring a median follow-up period of 1020 days, 71 patients (4.7%) developed ischemic stroke, and the cumulative incidence of ischemic stroke was 4.0% at 1 year and 4.7% at 3 years. Independent risk factors of ischemic stroke included pancreatic cancer (HR: 4.24 [95%CI: 2.13-8.43]), ovarian cancer (HR: 2.82 [95%CI: 1.31-6.08]), lung cancer (HR: 2.35 [95%CI: 1.20-4.57]), dyslipidemia (HR: 1.76 [95%CI: 1.01-3.09]), metastasis (HR: 1.70 [95%CI: 1.02-2.82]), higher D-dimer level at VTE diagnosis (HR: 1.09 [95%CI: 1.04-1.14]), and younger age (HR: 0.84 [95%CI: 0.71-0.999]). ConclusionsIn this large VTE registry in the DOAC era, the cumulative incidence of ischemic stroke was 4.0% at 1 year and 4.7% at 3 years in patients with CAVTE, and several independent risk factors of ischemic stroke were identified, including pancreatic cancer, ovarian cancer, lung cancer, dyslipidemia, metastasis, higher D-dimer levels at VTE diagnosis, and younger age.

Acute angle-closure glaucoma before, during, and after the outbreak of COVID-19 in China

ObjectivesAcute angle-closure glaucoma (AACG) is a major cause of irreversible and severe visual function loss. Robust rise in AACG was observed in the ophthalmic outpatient clinics concomitant with the outbreak of COVID-19 infection in China after the relaxing of “zero-COVID policy” in early December 2022. Here we compared the demographic and clinical profiles of patients with AACG before, during and after the COVID-19 outbreak. Underlying mechanisms were tentatively investigated. MethodsThis is a retrospective comparative study. Consecutive cases with newly diagnosed AACGs in a tertiary eye hospital were retrospectively collected during December 17, 2022 to January 8, 2023. Data from the same period in 2018–2019 and 2019–2020, 2020–2021 and 2021–2022, and 2023–2024 were collected as pre-pandemic, pandemic-control, and post-pandemic control, respectively. For the patients in 2022–2023 outbreak group, COVID-19 infection was confirmed by reversed transcriptase-polymerase chain reaction or antibody test for severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) from nasopharyngeal swabs. Ocular parameters, serum electrolytes and coagulative parameters were compared between COVID-19 positive and negative AACGs in observational group. SARS-CoV-2 nucleic acid in the aqueous humor was detected. ResultsA total of 106 AACG cases were diagnosed during the outbreak period in 2022–2023. In contrast, 18 (in 2018–2019) and 22 (in 2019–2020) cases were included during pre-pandemic period, and 21 (in 2023–2024) during the post-pandemic period. Only 13 and 4 newly onset AACG were included in 2020–2021 and 2021–2022 during the pandemic-control period, respectively. Younger age and higher proportion of bilateral involvement were detected in COVID-19 outbreak group than that of other groups (p = 0.034 and p = 0.080). Sixty-eight (64.2 %) patients in the outbreak group had a confirmed COVID-19 infection. Intervals between infection and AACG attack was 52 ± 85h (0-15d). Fifty-three patients (77.9 %) reported the applications of ibuprofen or other antipyretic medications and 25 (36.8 %) reported large volume water intake before AACG attack. COVID-19-positive AACG patients had higher level of D-dimer than their negative counterparts (1.13 ± 2.60 mg/L vs. 0.46 ± 0.43 mg/L, p = 0.083). No difference in IOP, serum electrolytes, and coagulative parameters other than D-dimer was observed between COVID-19 positive and negative cases. SARS-CoV-2 were negative in the aqueous humor from 14 COVID-19 positive and 8 negative patients. ConclusionCOVID-19 infection surged the onset of AACG in patients at risk. Mental stress, water intake, increased choroidal thickness due to SARS-CoV-2 induced ACE receptor activation, and hyper-coagulation, may contribute to the disease onset. Ocular involvement should not be ignored in both routine and new systemic emergent conditions.

Optimal choice of indicators for timely assessment of the prognosis of COVID-19 in hospitalized patients

The aim of the study was to identify the indicators that are most significant for predicting the features of the course of COVID-19 in hospitalized patients.Materials and methods. 250 case histories of patients aged 18 to 86 years with COVID-19 hospitalized in the hospital of the city of Nukus, Republic of Uzbekistan, redesigned to provide care to patients with COVID-19 from July 1, 2020 to March 2022, were analyzed. Patients who had a wave–like course of the disease with the development of complications, an increase in the volume of lung damage, were included in the main group (62 patients, 3 of whom were extremely severe). The patients who had stable positive dynamics (188 people) formed a comparison group.Results and discussion. Among patients over 65 years of age, 36% had a complicated course, in the 45–65 age group — 29% (p&gt;0.05), and among patients under 45 years of age — 13% (p&lt;0.05). The main group was dominated by men (79%). Among hospitalized villagers, an increase in the severity of the condition was noted in 30% of cases, and among patients from the city of Nukus, such patients were 20% (p&lt;0.05). The highest values of D-dimer, interleukin-6 and C-reactive protein were in both groups, significant differences between the groups were revealed in the levels of D-dimer and interleukin-6. Significant differences between the groups were found in the levels of D-dimer, interleukin-6, ferritin, ALT, AST, and urea.Conclusion. COVID-19 has become one of the most studied diseases to date, but aspects of the course of this disease in certain population groups are still not sufficiently investigated. The complicated, progressive course of COVID-19, according to the results of our study, was recorded in all age groups of the adult population, more often in men from rural areas aged over 45 years with chronic diseases. The main prognostic markers of the complicated and progressive course of COVID-19 should be considered high levels of D-dimer, interleukin-6 and ferritin.

Magnetic resonance (MR) evaluation of deep venous thrombosis of 338 discharged viral pneumonia patients.

Viral pneumonia (VP) often leads to the development of deep vein thrombosis (DVT) in hospitalized patients. The aim of the study was to investigate the incidence of DVT in discharged patients with VP, and whether new and old DVT differ in transverse relaxation time. In this prospective cohort study in Wuhan, China, 338 consecutive discharged VP patients from February 2021 to March 2023 who underwent T2 weighted Sampling Perfection with Application Optimized Contrast Evolution (SPACE) were recruited to detect DVT. T2 mapping and T2* mapping were performed for the patients with DVT detected by magnetic resonance imaging (MRI). The minimum, maximum, mean of T2 time and T2* time of DVT were recorded as T2min, T2max, T2mean, T2*min, T2*max, and T2*mean, respectively. Clinical data and laboratory findings were compared between new and old DVT cases, which were defined based on the examination results before and after discharge. A Mann-Whitney test was used to compare transverse relaxation time parameters between new and old DVT. Twelve percent of VP patients (40/338) developed new DVT after discharge. Thirty-three out of 104 DVTs did not resolve after discharge. Compared with patients with new DVT, patients with old DVT were older (67 vs. 59 years, P=0.003); and had a higher proportion of bedridden time >72 hours (72.7% vs. 37.0%, P<0.001). Patients with old DVT had a lower lymphocyte count (0.67×109/L vs. 0.97×109/L, P=0.01), higher C-reactive protein (59 vs. 35 mg/L, P=0.019), and higher levels of D-dimer (6.7 vs. 0.9 µg/mL, P<0.001) than patients with new DVT. Patients with old DVT received more invasive mechanical ventilation (30.3% vs. 7.4%, P<0.001) and had a higher proportion of acute respiratory distress syndrome (75.8% vs. 51.9%, P<0.001), and a higher proportion of cardiac injury (39.4% vs. 14.8%, P=0.033) than patients with new DVT. T2min, T2max, T2mean, and T2*max of new DVT were significantly greater than old DVT (17.6±10.4 vs. 13.2±5.9 ms, 94.9±44.9 vs. 42.3±23.6 ms, 46.8±24.0 vs. 25.0±12.6 ms, 22.5±12.4 vs. 10.7±3.5 ms, P<0.05 for all). There was no significant difference in T2*min or T2*mean between new and old DVT (3.2±0.4 vs. 3.1±0.4 ms, 8.2±4.9 vs. 5.5±1.5 ms, P>0.05 for both). T2 weighted SPACE magnetic resonance (MR) is valuable in the follow-up of thrombosis of discharged VP patients. T2 mapping distinguishes between new and old DVT.

A Silent Threat: Deep Vein Thrombosis in Early-Stage Parkinson's Disease.

The primary clinical manifestation of venous thrombosis is discomfort in the lower extremities. Some early Parkinson's disease (PD) patients feel discomfort in the lower limbs. Venous thrombosis can risk lives by causing pulmonary embolism. This study examines the incidence of DVT in early PD patients and its correlation with different clinical and lab features. A cross-sectional study was conducted on 117 patients with early-stage PD. Ultrasonography was employed to detect the presence of DVT. Factors such as age, gender, body mass index, lifestyle habits (smoking and drinking), medical history (hypertension, diabetes, atrial fibrillation, and tumor), and other lab tests linked to thrombosis were analyzed. In 117 patients, 11 (9.4%) had DVT, while 106 (90.6%) did not. There were no significant differences in gender, BMI, habits, medical history, or other thrombosis-related tests between both groups. However, DVT patients were older with higher d-dimer levels. They also showed an increased right substantia nigra ultrasound echo area, higher HY grades, higher UPDRS 3 scores, less improvement in UPDRS 3 scores and levodopa response. The primary risk factors for lower extremity venous thrombosis were found to be age, d-dimer levels, and low-dose levodopa. Therefore, for elderly patients with early-stage PD, it is crucial to conduct d-dimer and lower extremity vascular ultrasound tests. The prevention of venous thrombosis in the lower extremities of early PD patients is of utmost importance.

High Plasma D-Dimer Levels Correlate with Ictal Infarction and Poor Outcomes in Spontaneous Subarachnoid Hemorrhage

Early brain injury is the leading cause of poor outcomes in spontaneous subarachnoid hemorrhage (sSAH). Plasma D-dimer levels and acute cerebral ischemia have been highlighted as relevant findings in early brain injury; however, their correlation has not been substantially investigated. This retrospective, single-center cohort study was conducted at a tertiary emergency medical center from January 2004 to June 2022. Consecutive patients with sSAH who presented within 12hours of ictus and underwent magnetic resonance imaging within 3days were included. We assessed the correlation of plasma D-dimer levels with acute ischemic lesions detected on the diffusion-weighted imageing and the clinical characteristics. Among 402 eligible patients (mean age, 63.5years; 62.7% women; median time from onset to arrival, 45.5minutes), 140 (34.8%) had acute ischemic lesions. Higher plasma D-dimer levels linearly correlated with worse neurological grades, more severe SAH on initial computed tomography, acute ischemic lesions, and poor outcomes, except for patients with neurogenic stunned myocardium. In the multivariate analysis, acute ischemic lesions were significantly associated with worse neurological grades, higher plasma D-dimer levels, bilateral loss of light reaction, and advanced age. The receiver operating characteristic curve analysis showed D-dimer levels as excellent predictors for acute ischemic lesions (area under the curve, 0.897; cut-off value, 5.7μg/mL; P<0.0001) and unfavorable outcomes (area under the curve, 0.786; cut-off value, 4.0μg/mL; P<0.0001). High plasma D-dimer levels correlated with the appearance of acute ischemic lesions on diffusion-weighted imaging and were dose-dependently associated with worse neurological grades, more severe hemorrhage, and worse outcomes.

A Retrospective Study: Evaluating the Impact of the COVID-19 Pandemic on Inflammatory Markers in Hospitalized Patients.

The COVID-19 pandemic has had a significant impact globally, and understanding the relationship between inflammatory markers and disease progression is crucial for effective management. This retrospective study aimed to examine the association between various inflammatory markers, such as C-reactive protein (CRP), the erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), D-dimer, ferritin, and procalcitonin (PCT), and the characteristics of disease progression and outcomes in individuals affected by COVID-19. This study collected raw data from 470 patients who tested positive for SARS-CoV-2 using RT-PCR. The logistic regression analysis revealed that elevated LDH levels were associated with male gender, ICU admission, low oxygen saturation (O2 < 93%), the need for mechanical ventilation, death, and the presence of lung infiltrates. Higher D-dimer levels were associated with older age, diabetes mellitus, cardiac disease, and low oxygen saturation. Ferritin levels were significantly associated with older age, ICU admission, low oxygen saturation, mechanical ventilation, and lung infiltrates. In contrast, CRP was only significant regarding lung infiltrates and procalcitonin levels were not significantly associated with any of the examined factors. This study highlights the importance of monitoring key inflammatory markers, such as LDH, D-dimer, and ferritin, as they are significantly associated with the severity of COVID-19 illness. These findings can inform clinical decision-making and guide the development of targeted interventions to improve patient outcomes.

Tourniquet Effect on Patients Undergoing Total Knee Arthroplasty: A Single-Blind, Randomized Controlled Trial.

Tourniquet is applied in Total Knee Arthroplasty (TKA) to reduce intraoperative blood loss and improve view of surgical field. However, tourniquet use in TKA is still in dispute. Some researchers find that tourniquet may lead to extra side effects such as aggravated pain and limb swelling, while others consider that tourniquet has no significant adverse impact on clinical outcomes of TKA patients. This trial is conducted to evaluate tourniquet effect on TKA patients. A prospective, single-blind, randomized controlled trail is adopted with a sample size of 130 knees from August 2020 to February 2023. Patients undergoing TKA are randomly allocated to tourniquet group and non-tourniquet group. Outcomes including quadriceps thickness and stiffness, operation time, total blood loss, intraoperative blood loss, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer and CRP level, knee function score, patient satisfaction, and complications are evaluated in this trial. Student's t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test are used in this study. No significant difference in demographic information and baseline outcomes were found (p > 0.05). Participants in the tourniquet group had significantly less total blood loss and intraoperative blood loss, more postoperative blood loss, and higher D-Dimer level on postoperative day 3 when compared with non-tourniquet group (p < 0.05). Other outcomes including quadriceps thickness and stiffness, operation time, postoperative blood loss, transfusion rate, thigh circumference, knee and thigh VAS, D-Dimer level on postoperative day 1, CRP level, knee function score, patient satisfaction, and complications showed no significant difference (p > 0.05). Tourniquet application can effectively reduce intraoperative blood loss and total blood loss, without significant side effects. Hence, we advocate the regular use of tourniquet in primary TKA.

Biochemical implication of acetylcholine, histamine, IL-18, and interferon-alpha as diagnostic biomarkers in hepatitis C virus, coronavirus disease 2019, and dual hepatitis C virus-coronavirus disease 2019 patients.

Globally, hepatitis C virus (HCV) andcoronavirus disease 2019(COVID-19) are the most common causes of death due to the lack of early predictive and diagnostic tools. Therefore, research for a new biomarker is crucial. Inflammatory biomarkers are critical central players in the pathogenesis of viral infections. IL-18, produced by macrophages in early viral infections, triggers inflammatory biomarkers and interferon production, crucial for viral host defense. Finding out IL-18 function can help understand COVID-19 pathophysiology and predict disease prognosis. Histamine and its receptors regulate allergic lung responses, with H1 receptor inhibition potentially reducing inflammation insevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. angiotensin-converting enzyme 2 (ACE-2) receptors on cholangiocytes suggest liver involvement in SARS-CoV-2 infection. The current study presents the potential impact of circulating acetylcholine, histamine, IL-18, and interferon-Alpha as diagnostic tools in HCV, COVID-19, and dual HCV-COVID-19 pathogenesis. The current study was a prospective cross-section conducted on 188 participants classified into the following four groups: Group 1 COVID-19 (n = 47), Group 2 HCV (n = 47), and Group 3 HCV-COVID-19 patients (n = 47), besides the healthy control Group 4 (n = 47). The levels of acetylcholine, histamine, IL-18, and interferon-alpha were assayed using the ELISA method. Liver and kidney functions within all groups showed a marked alteration compared to the healthy control group. Our statistical analysis found that individuals with dual infection with HCV-COVID-19 had high ferritin levels compared to other biomarkers while those with COVID-19 infection had high levels of D-Dimer. The histamine, acetylcholine, and IL-18 biomarkers in both COVID-19 and dual HCV-COVID-19 groups have shown discriminatory power, making them potential diagnostic tests for infection. These three biomarkers showed satisfactory performance in identifying HCV infection. The IFN-Alpha test performed well in the HCV-COVID-19 group and was fair in the COVID-19 group, but it had little discriminative value in the HCV group. Moreover, our findings highlighted the pivotal role of acetylcholine, histamine, IL-18, and interferon-Alpha in HCV, COVID-19, and dual HCV-COVID-19 infection. Circulating levels of acetylcholine, histamine, IL-18, and interferon-Alpha can be potential early indicators for HCV, COVID-19, and dual HCV-COVID-19 infection. We acknowledge that further large multicenter experimental studies are needed to further investigate the role biomarkers play in influencing the likelihood of infection to confirm and extend our observations and to better understand and ultimately prevent or treat these diseases.

Distinct clinical characteristics of bocavirus and Mycoplasma pneumoniae infection in children plastic bronchitis.

This study investigated clinical and laboratory characteristics of human bocavirus type 1 (HBoV1)-plastic bronchiolitis (PB), Mycoplasma pneumoniae (MP)-associated plastic bronchitis (PB) and MP-NPB in children, highlighting inflammation, coagulation, and bronchoscopic needs. Data on preschool children with PB during HBoV1 or MP infection were collected, comparing MP-PB to severe Mycoplasma pneumoniae pneumonia. Compared with the MP-PB group, the HBoV1-PB group, with younger children, had significantly milder clinical symptoms but higher WBC counts (p = .028). The MP-PB group exhibited notably elevated Fibrinogen (p = .045) and d-dimer levels (p < .001). When contrasting the MP-PB with the MP-NPB group, children in MP-PB group still had higher levels of d-dimer and increased inflammatory indicators such as C-reactive protein, procalcitonin, lactate dehydrogenase, and interleukin-6, which were significantly elevated compared with the MP-NPB group. MP-PB showed a higher prevalence of plastic bronchial casts in lower lobes (p = .016) and a dominance of neutrophils in BALF cytology. Additionally, children in the MP-PB group tended to undergo a greater number of bronchoscopies. This study identifies key differences in plastic bronchitis in children due to HBoV1 and MP, highlighting HBoV1's milder inflammation in younger kids and MP's link to severe inflammatory and coagulation responses, guiding clinical diagnosis and treatment.